Objective: The aim of our study was the evaluation of sonographic fetal weight estimation taking into consideration 9 of the most important factors of influence on the precision of the estimation. Methods: We analyzed 820 singleton pregnancies from 22 to 42 weeks of gestational age. We evaluated 9 different factors that potentially influence the precision of sonographic weight estimation (time interval between estimation and delivery, experts vs. less experienced investigator, fetal gender, gestational age, fetal weight, maternal BMI, amniotic fluid index, presentation of the fetus, location of the placenta). Finally, we compared the results of the fetal weight estimation of the fetuses with poor scanning conditions to those presenting good scanning conditions. Results: Of the 9 evaluated factors that may influence accuracy of fetal weight estimation, only a short interval between sonographic weight estimation and delivery (0–7 vs. 8–14 days) had a statistically significant impact. Conclusion: Of all known factors of influence, only a time interval of more than 7 days between estimation and delivery had a negative impact on the estimation.

Objective To evaluate an ultrasound training system designed to standardize teaching and learning of gynecological sonography using a virtual model. Methods

P reterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintupletpregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher's exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the "no cerclage-triplets", while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGARScore and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.Prematurity has the highest impact on the outcome of multiple pregnancies. The risk of preterm birth and analogous adverse fetal outcome increases with the number of fetuses. For twins, it is up to four times that in singletons (Day et al., 1997). The incidence of preterm delivery is reported to be 30-50% in twins and 66-100% in higher order multiples (Crowther, 1998). Preterm labor, premature preterm rupture of the membranes (PPROM) or cervical dilatation can lead to preterm delivery. Effective prevention of preterm birth would be the major breakthrough with a significant impact on the outcome of multiple pregnancies.Cervical dilatation is a frequent complication particularly in case of multiple pregnancies and is sometimes considered an indication for prophylactic cervical cerclage. The true incidence of the cervical affection is difficult to assess. In the literature, a range from 8-15% is reported.Several prenatal interventions aimed at prolonging multiple pregnancies have been validated. Two trials that assessed the value of prophylactic cervical cerclage in 50 and 194 twin pregnancies found no difference concerning the risk of preterm birth or perinatal mortality (Dor et al., 1982;Rush et al., 1984). Nevertheless, the presented data is too sparse to give any clear picture of the potential effects of routine cerclage in twins.The aim of this study is to evaluate the effect of prophylactic cervical cerclage on perinatal outcome of higher order multiple pregnancies in order to clarify the "cerclage dilemma". Materials and M...

No abstract

P reterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintupletpregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher's exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the "no cerclage-triplets", while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGARScore and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.Prematurity has the highest impact on the outcome of multiple pregnancies. The risk of preterm birth and analogous adverse fetal outcome increases with the number of fetuses. For twins, it is up to four times that in singletons (Day et al., 1997). The incidence of preterm delivery is reported to be 30-50% in twins and 66-100% in higher order multiples (Crowther, 1998). Preterm labor, premature preterm rupture of the membranes (PPROM) or cervical dilatation can lead to preterm delivery. Effective prevention of preterm birth would be the major breakthrough with a significant impact on the outcome of multiple pregnancies.Cervical dilatation is a frequent complication particularly in case of multiple pregnancies and is sometimes considered an indication for prophylactic cervical cerclage. The true incidence of the cervical affection is difficult to assess. In the literature, a range from 8-15% is reported.Several prenatal interventions aimed at prolonging multiple pregnancies have been validated. Two trials that assessed the value of prophylactic cervical cerclage in 50 and 194 twin pregnancies found no difference concerning the risk of preterm birth or perinatal mortality (Dor et al., 1982;Rush et al., 1984). Nevertheless, the presented data is too sparse to give any clear picture of the potential effects of routine cerclage in twins.The aim of this study is to evaluate the effect of prophylactic cervical cerclage on perinatal outcome of higher order multiple pregnancies in order to clarify the "cerclage dilemma". Materials and M...